AB1048 ENTHESAL ULTRASOUND ABNORMALITIES CAN PRECEDE SPA DEVELOPMENT IN ASYMPTOMATIC IBD PATIENTS. A RETROSPECTIVE STUDY
Authors: A. Batticciotto, F. Campanaro, G. M. C. La Paglia, A. Locatelli, M. Vaiano, S. Ardizzone, A. Cappelli, P. Sarzi-Puttini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Nearly four million people worldwide are affected by Inflammatory Bowel Diseases (IBD) and approximately 25-40% of them develop extra-intestinal manifestations, such as arthritis and enthesitis. Enthesis inflammation is a cornerstone in Spondyloarthritis (SpA) but there are few data concerning prevalence, clinical presentation and prognostic value of enthesitis in IBD patients. Ultrasound (US) assessment has emerged as a feasible, reliable and easily accessible technique for the detection of enthesis abnormalities. Recently a systematic review about the predictive value of the US elementary lesions in IBD patients was performed [1]. Multicenter studies performed on IBD patients without clinical signs of SpA demonstrated high prevalence of US entheses abnormalities such as dishomogeneous echostructure and Power Doppler (PD) positivity [2-3]. The predictive role of these abnormalities is up to now unknown. <h3>Objectives</h3> To find US abnormalities that can predict or frequently precede the development of SpA in a population of IBD patients asymptomatic for entheseal involvement. <h3>Methods</h3> We conducted a retrospective analysis of clinical and US enthesis data coming from 29 patients affected by IBD without clinical signs of SpA evaluated in the period between 2010 and 2012 at the combined Gastroenterology/Pediatrics/Rheumatology Clinic and still in follow up in the Gastroenterology and Rheumatologic Unit of L. Sacco University Hospital in 2022. After a long term follow-up from the first combined US (according to MASEI score with ESAOTE MyLab 70 linear probe 6-18 MHz) and clinical evaluation we retrospectively analyze the patient's clinical record in order to find which patients developed clinically a SpA according to the Assessment of SpondyloArthritis international Society (ASAS) criteria [4]. Medium MASEI score and the presence of US elementary entheseal lesions at baseline of patients that develop SpA were compared by chi-squared test with those without signs of joint involvement. <h3>Results</h3> After an average follow-up of ten years we evaluated data from 29 patients (19 F and 10 M) with a mean age of 33,38 (range 17-82) years and mean disease duration of 14,1 (range 11-33) years. Four patients out of 29 (14%) developed a SpA. Reviewing their US baseline evaluation and comparing it with those of patients that didn't develop the disease we have found that the medium MASEI score of those who developed a SpA was statistically higher (18 ± 13,3 Vs 8,2 ± 6,6 p=0,02). Focusing on US elementary lesions (Table 1) we can underline that all patients developing SpA had at baseline at least one entheses with a positive PD signal (Vs 9/25 of the comparing group (p=0,02). <h3>Conclusion</h3> MASEI score and PD US positivity at enthesal level are possible predicting factors for the development of SpA in IBD patients. Further investigations from long term prospective studies need to confirm these preliminary data. <h3>References</h3> [1]Sakellariou G, et al. Musculoskeletal Ultrasound to Identify Subclinical Joint and Periarticular Involvement in Patients With Inflammatory Bowel Disease: A Systematic Literature Review. Front Med (Lausanne). 2022;9 [2]Rovisco J, et al. Hidden musculoskeletal involvement in inflammatory bowel disease: a multicenter ultrasound study. BMC Musculoskelet Disord. 2016;17:84 [3]Batticciotto A, et al SAT596 Ultrasonographic Evaluation of Subclinical Enthesitis in Patients Affected by Pediatric Inflammatory Bowel Disease Annals of the Rheumatic Diseases 2015;74:877 [4]Rudwaleit M, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-83 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.